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Qcor-Annual-Report-2017.Pdf Queensland Health Queensland Health Improvement | Transparency | Patient Safety | Clinician Leadership | Innovation Statewide Cardiac Clinical Network Queensland Cardiac Outcomes Registry 2017 Annual Report Clinical Excellence Division Creating solutions for better healthcare Interventional Cardiology Audit Contents 1 Message from the SCCN Chair 1 Interventional Cardiology Audit 2 Introduction 2 7 Message from the QCOR Interventional Cardiology Committee Chair IC 3 3 Executive summary 4 8 Key findings IC 4 4 Acknowledgements and authors 5 9 Participating sites IC 5 5 QCOR Committees 7 9.1 Statewide IC 6 6 Future plans 9 9.2 Cairns Hospital IC 7 9.3 The Townsville Hospital IC 7 9.4 Mackay Base Hospital IC 8 9.5 Sunshine Coast University Hospital IC 8 9.6 The Prince Charles Hospital IC 9 9.7 Royal Brisbane and Women’s Hospital IC 9 9.8 Princess Alexandra Hospital IC 10 9.9 Gold Coast University Hospital IC 10 10 Total cases IC 11 10.1 Procedure type IC 11 10.2 Total cases by diagnosis IC 12 11 Patient characteristics IC 13 11.1 Age and gender IC 13 11.2 Body mass index IC 14 11.3 Place of residence IC 15 11.4 Aboriginal and Torres Strait Islander status IC 17 12 Care and treatment of PCI patients IC 19 12.1 Admission status IC 19 12.2 Access route IC 21 12.3 Vessels treated IC 22 12.4 Stent type IC 23 12.5 NSTEMI IC 24 12.6 PCI following presentation with STEMI IC 27 13 Clinical indicators IC 29 13.1 Mortality outcomes IC 30 13.2 STEMI less than 6 hours from symptom onset – time to reperfusion IC 34 13.3 NSTEMI – time to angiography IC 39 13.4 Major procedural complications IC 41 13.5 Safe radiation doses IC 42 14 Conclusions IC 43 This report is available online at: 15 Recommendations IC 44 https://clinicalexcellence.qld.gov.au/priority-areas/ 16 Supplement: Structural heart disease IC 45 clinician-engagement/statewide-clinical-networks/ 16.1 Participating sites IC 45 cardiac 16.2 Patient characteristics IC 46 For all enquiries, please contact the Statewide 16.3 Care and treatment of SHD patients IC 47 Cardiac Clinical Informatics Unit at: 16.4 Patient outcomes IC 50 [email protected] Cardiac Surgery Audit Electrophysiology and Pacing Audit 17 Message from the QCOR Cardiothoracic 28 Message from the QCOR Electrophysiology and Committee Chair CS 3 Pacing Committee Chair EP 3 18 Key findings CS 4 29 Key findings EP 4 19 Participating sites CS 5 30 Participating sites EP 5 20 Case totals CS 7 31 Case totals EP 8 20.1 Total cases CS 7 31.1 Total cases EP 8 20.2 Cases by category CS 8 31.2 Cases by category EP 9 21 Patient characteristics CS 9 32 Patient characteristics EP 10 21.1 Age and gender CS 9 32.1 Age and gender EP 10 21.2 Body mass index CS 11 32.2 Body mass index EP 12 21.3 Aboriginal and Torres Strait Islander 32.3 Aboriginal and Torres Strait Islander status CS 12 status EP 13 22 Risk factor profile CS 13 33 Risk factors and comorbidities EP 14 22.1 Smoking history CS 13 33.1 Coronary artery disease EP 14 22.2 Diabetes CS 13 33.2 Family history of sudden cardiac death EP 14 22.3 Hypertension CS 14 33.3 Smoking history EP 15 22.4 Statin therapy CS 14 33.4 Diabetes EP 15 22.5 Renal impairment CS 14 33.5 Hypertension EP 15 22.6 Severe renal dysfunction CS 15 33.6 Dyslipidaemia EP 16 22.7 Left ventricular function CS 15 33.7 Atrial arrhythmia history EP 16 22.8 Summary of risk factors CS 16 33.8 Heart failure EP 16 33.9 Valvular heart disease EP 17 23 Care and treatment of patients CS 17 23.1 Admission status CS 17 33.10 Other cardiovascular disease and co-morbidities EP 17 23.2 Day of surgery admission CS 18 33.11 Renal impairment EP 18 23.3 Coronary artery bypass grafts CS 19 33.12 Anticoagulation EP 18 23.4 Aortic surgery CS 21 33.13 LV function EP 18 23.5 Valve surgery CS 22 23.6 Other cardiac surgery CS 26 34 Care and treatment of patients EP 19 23.7 Blood product usage CS 27 34.1 Urgency category EP 19 34.2 Admission source EP 20 24 Outcomes CS 28 34.3 Admission source and urgency category EP 21 24.1 Risk prediction models CS 28 34.4 Device procedures EP 22 25 Conclusions CS 35 34.5 Electrophysiology studies/ablations EP 23 34.6 Other procedures EP 31 26 Recommendations CS 35 27 Supplement: Infective endocarditis CS 36 35 Procedural complications EP 32 27.1 Patient characteristics CS 38 36 Conclusions EP 34 27.2 Care and treatment of infective endocarditis patients CS 39 37 Recommendations EP 34 27.3 Comorbidities CS 41 27.4 Microbiology CS 41 27.5 Patient outcomes CS 42 27.6 Discussion CS 43 Cardiac Rehabilitation Audit Heart Failure Support Services Audit 38 Message from the QCOR Cardiac Rehabilitation 48 Message from the Heart Failure Services Committee Chair CR 3 Steering Committee Chairs HF 3 39 Key findings CR 5 49 Key findings HF 4 40 Participating sites CR 6 50 Participating sites HF 6 41 Total referrals CR 8 51 New referrals HF 9 51.1 Location of referrals HF 9 42 Patient characteristics CR 10 42.1 Age and gender CR 10 51.2 Referral source HF 11 42.2 Aboriginal and Torres Strait Islander status CR 11 52 Patient characteristics HF 12 52.1 Age HF 12 43 Total assessments CR 13 52.2 Gender HF 13 44 Clinical presentation CR 14 52.3 Aboriginal and Torres Strait Islander 44.1 Diagnosis CR 14 status HF 15 44.2 Risk factors and comorbidities CR 15 52.4 Classification of heart failure by left 44.3 Current medications CR 19 ventricular ejection fraction HF 16 52.5 Summary of patient characteristics HF 18 45 Clinical indicators CR 20 45.1 Timely referral CR 21 53 Clinical indicators HF 19 45.2 Timely assessment CR 22 53.1 First clinical review HF 20 53.2 Left ventricular ejection fraction (LVEF) 46 Conclusions CR 24 assessed within 2 years of referral to 47 Recommendations CR 24 HFSS HF 24 53.3 Prescription of ACEI or ARB for patients with HFrEF HF 26 53.4 Prescription of guideline recommended beta blockers for HFrEF HF 30 53.5 Beta blocker titration HF 34 53.6 Summary of clinical indicators HF 40 54 Patient outcomes HF 42 54.1 Methods HF 42 54.2 Findings HF 43 54.3 Discussion HF 47 55 Conclusions HF 48 56 Recommendations HF 49 57 Appendix: List of ICD10-AM Codes HF 50 Reference and Glossary 58 References i 59 Glossary iv 60 Upcoming initiatives v Interventional Cardiology Audit Figures Figure A: Operational structure 2 Interventional Cardiology Audit Figure B: QCOR 2017 infographic 3 Figure 1: PCI cases by residential postcode IC 6 Figure 2: Cairns Hospital IC 7 Figure 3: The Townsville Hospital IC 7 Figure 4: Mackay Base Hospital IC 8 Figure 5: Sunshine Coast University Hospital IC 8 Figure 6: The Prince Charles Hospital IC 9 Figure 7: Royal Brisbane and Women’s Hospital IC 9 Figure 8: Princess Alexandra Hospital IC 10 Figure 9: Gold Coast University Hospital IC 10 Figure 10: Proportion of all PCI cases by gender and age group IC 13 Figure 11: Proportion of all PCI cases by body mass index category IC 14 Figure 12: Queensland PCI cases by distance to nearest PCI facility IC 16 Figure 13: Proportion of all PCI cases by identified Aboriginal and Torres Strait Islander status IC 17 Figure 14: Proportion of all PCI cases by age group and Aboriginal and Torres Strait Islander status IC 18 Figure 15: Proportion of all PCI cases by admission status IC 20 Figure 16: Proportion of cases including at least one stent by site and stent type IC 23 Figure 17: Proportion of NSTEMI direct presenters receiving angiography within 72 hours, 2015 to 2017 IC 25 Figure 18: Proportion of NSTEMI interhospital transfers receiving angiography within 72 hours, 2015 to 2017 IC 26 Figure 19: Proportion of STEMI cases by first medical contact IC 27 Figure 20: Comparison of observed and predicted mortality rates by site IC 31 Figure 21: Comparison of observed and predicted mortality rates by site, excluding salvage IC 31 Figure 22: STEMI presenting within 6 hours of symptom onset – median first diagnostic ECG to first device time by admission pathway IC 35 Figure 23: Proportion of STEMI cases (<6 hours of symptom onset) where time from first diagnostic ECG to reperfusion met 90 minute target, 2015–2017 IC 36 Figure 24: STEMI under 6 hours pre-hospital component breakdown – QAS direct to PCI facility IC 37 Figure 25: Proportion of cases where door to device ≤60 minutes was met for STEMI presenting within 6 hours of symptom onset, 2015–2017 IC 38 Figure 26: Proportion of NSTEMI cases meeting time to angiography target of 72 hours, 2015–2017 IC 40 Figure 27: Documented immediate major procedural complications by site IC 41 Interventional Cardiology Audit Interventional Cardiology Audit Cardiac Surgery Audit Figure 1: Proportion of all SHD cases by gender Figure 1: Cardiac surgery cases by residential and age group IC 46 postcode CS 5 Figure 2: Proportion of all transcatheter valvular Figure 2: The Townsville Hospital CS 6 interventions by valve type IC 48 Figure 3: The Prince Charles Hospital CS 6 Figure 4: Princess Alexandra Hospital CS 6 Figure 5: Gold Coast University Hospital CS 6 Figure 6: Proportion of cases by site and surgery category CS 8 Figure 7: Proportion of all cases by age group and gender CS 9 Figure 8: Proportion of cases by gender and surgery category CS 10 Figure 9: Proportion of cases by BMI and surgery category CS 11 Figure 10: Proportion of cases by identified Aboriginal and Torres Strait Islander status and surgery category CS 12 Figure 11: Proportion of cases by smoking status and surgery category CS 13 Figure 12: Proportion of cases by diabetes status and surgery category CS 13 Figure 13: Proportion of cases by hypertension status and surgery category CS 14 Figure 14: Proportion of cases by statin therapy status and
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